Tobacco Research in China and the Tobacco Atlas


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training workshop sponsored by the China CDC for 12 cities that are participating in the Smoke-Free Cities project. Michael Eriksen, ScD

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Tobacco Research in China and the Tobacco Atlas

  1. 1. Tobacco Control Research in China and The Tobacco Atlas
  2. 2. • Harm • Products and Their Use • Costs • Tobacco Industry • Solutions Research Areas Corresponding to The Tobacco Atlas
  3. 3. • Biologic and toxicologic research • Epidemiologic research • Economic research • Health promotion research • Evaluation research • Policy and regulatory research • Legal research Koplan, Eriksen, Chen, Yang. The value of research as a component of successful tobacco control in China. Tob Control doi:10.1136/tobaccocontrol-2013-051054 Framework for Tobacco Control Research in China
  4. 4. Stages of the Tobacco Epidemic Harm and Use Over Time Thun M et al. Tob Control 2012;21:96-101
  5. 5. Harm from Tobacco Use One billion tobacco-related deaths are expected in the 21st century and smoking harms every organ of the body.
  6. 6. Harm from “Forced smoking” • 600,000 deaths annually from secondhand smoke exposure (mostly women and children) • More women die in China from exposure to second hand smoke than die from smoking themselves
  7. 7. – Calculate the exposure to and impact of secondhand smoke • at home, • at work, and • combined at work and home? – What are the synergistic effects of smoking, combined with air pollution, on Chinese public health? – Are the relative risks of diseases caused by smoking different in China? If so, why? Possible research questions related to harm caused by smoking
  8. 8. The Western Pacific Region of the world consumes almost half of all cigarettes and China consumes 38% of the world’s cigarettes. Tobacco Products and Their Use
  9. 9. Tobacco Products and Their Use
  10. 10. Tobacco Products and Their Use
  11. 11. Benefits of Cessation Tobacco Products and Their Use Cumulative risk at UK male 1990 rates BMJ 2000; 321:323−9
  12. 12. – Why are Chinese women’s smoking rates so low and how can these low rates be maintained? – Why do Chinese teenage boys have low smoking rates while Chinese adult men have high rates? What is responsible for this delayed initiation? – What is the likelihood that electronic cigarettes will become a common source of nicotine, and what should be the appropriate public policy regarding e-cigarettes? – Why is there such a large cost differential in the price of a pack of cigarettes in China, and what impact does this have on tobacco control policies, especially tax increases? Possible research questions related to tobacco products and their use
  13. 13. Tobacco-related costs in China are growing. Costs Related to Tobacco Use 2000 $7.2 billion 2008 $28.9 billion Between 2000 and 2008, total costs attributable to tobacco use in China more than quadrupled Direct costs of smoking (size of figures proportional to total in USD)
  14. 14. – What are the economic costs of smoking in rural households, and how does that impact food availability? – What is a realistic estimate of the direct (healthcare costs) and indirect (loss of productivity) costs of smoking for China? – What is the appropriate level for government investment in tobacco control, and what needs to occur in order for that investment to be made? Research questions related to costs of tobacco use
  15. 15. The Western Pacific Region leads the world in cigarette manufacturing. The Tobacco Industry and Cigarette Production In 2010, 41% of the world’s cigarettes were produced in China.
  16. 16. CNTC leads all tobacco companies in total revenue and profits. The Tobacco Industry and Company Profits
  17. 17. China grows 43% of all the tobacco in the world, more than the next 9 leading tobacco growing countries combined. The Tobacco Industry and Tobacco Growing
  18. 18. Country 2000 Production (MT) 2009 Production (MT) 2000 vs. 2009 Percent Change China 2,563,850 3,067,928 20% Brazil 578,451 863,079 49% India 520,000 620,000 19% United States of America 477,753 373,440 -22% Malawi 98,675 208,155 111% Indonesia 146,100 181,319 24% Argentina 114,509 159,495 39% Italy 129,937 119,119 -8% Pakistan 107,700 104,996 -3% Zimbabwe 227,726 96,367 -58% 4,964,701 5,793,898 16.70% The world’s leading tobacco producers and change over time in tobacco leaf production. The Tobacco Industry and Tobacco Growing
  19. 19. Tobacco industry sponsorships in China are an everyday occurrence. The Tobacco Industry and Sponsorships
  20. 20. – What impact does having a state monopoly have on implementing effective tobacco control measures? Is there a way the monopoly can advance tobacco control? – If the Chinese tobacco industry was privatized, what would the optimal tax rate be to discourage smoking while also providing sufficient government revenue? – How can tobacco control progress in a way to minimize a negative impact on tobacco farming? – How can a government-owned tobacco industry be criticized in a patriotic country like China? Research questions related to the tobacco industry
  21. 21. Innovative plain packaging introduced in Australia. Tobacco Control Solutions
  22. 22. Shanghai Tobacco Company’s “I Love China” brand circumvents advertising bans. Tobacco Control Solutions
  23. 23. Clean indoor air laws make a difference. Tobacco Control Solutions Bill Gates and Baidu CEO Robin Li wear shirts reading “Say no to forced smoking”
  24. 24. Hong Kong implements successful smoking ban without negatively impacting restaurant sales. Tobacco Control Solutions
  25. 25. Support for smoke free hospitality in China Tobacco Control Solutions Sample of 814 restaurants and bars in five Chinese cities (Beijing, Xi’an, Wuhan, Kunming and Guiyang) found (Liu, 2011b): • 86% of nonsmoking subjects were exposed to at least a day of SHS at work each week • 51% knew SHS could cause heart disease • 17% supported prohibiting smoking in restaurants ; 11% supported prohibiting smoking in bars • 53% of subjects were willing to prohibit/restrict smoking in their venues – 82% of those unwilling to restrict smoking thought smoking bans would reduce revenue – 63% unwilling to restrict smoking thought indoor air quality depended on ventilation rather than bans Study indicates support for smoking bans among Chinese restaurant and bar owners and highlights knowledge gaps
  26. 26. – In China, what are the most effective tobacco control interventions, and are they different from those elsewhere in the world? – What is the most effective way to increase the currently low quit rates among Chinese men? – How can tobacco control progress be accelerated so that public health benefits can be achieved in years rather than decades? – How can smoking be made socially unacceptable in a culture where most men smoke and cigarettes are still given as gifts? – What laws and regulations need to be established to support tobacco control efforts in a relatively new and changing legal system where the government owns the tobacco industry? Research questions related to tobacco control solutions
  27. 27. Michael Eriksen Dean, School of Public Health Georgia State University Additional information available at: